1. Least Effective Exercises Slideshow
2. Dehydration Slideshow
3. First Aid Care and Pain Relief for Minor Injuries

Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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When surgery is considered, the ligament is not repaired but instead is reconstructed usually with minimally invasive surgery using an arthroscope. A variety of techniques may be used, and the orthopedic surgeon and patient usually discuss the options available before a decision as to what type of surgery is performed. The "new" ligament may be taken from part of the patellar tendon (the tendon that attached the quadriceps muscle to the tibia), from part of the hamstring tendon in the back of the knee, or it may be a donor or cadaver graft. Each option has its advantages and disadvantages.

Other structures in the knee may also be damaged in association with an ACL tear, including other ligaments and menisci (cartilage), and will often be repaired at the same time.

In children, instead of the ligament being torn, the ligament can pull a piece of bone off the tibial spine where it inserts. Surgery make be required to reattach the bony fragment instead of reconstructing the ligament.

Surgery is often the recommended option for patients with ACL injuries. The purpose of surgery is to return patients to their original level of activity. For patients who are sedentary and do not perform sports, or for those who perform light manual work and are involved in non-cutting sports like running and bicycling, nonoperative treatments of ACL injuries may be reasonable alternatives.

Surgery usually does not occur immediately after the injury but may be delayed three weeks or more. Time is allowed for the swelling and bleeding to decrease and to plan the operation. Recovery is measured in months, and it is reasonable to have the patient make arrangements for the rehabilitation and physical therapy that is required after the ACL reconstruction. The commitment to rehabilitation is an essential part of a successful operation.

In the time prior to surgery, many patients are encouraged to "pre-hab" their injured leg. When the knee is injured, the quadriceps muscle tendons weaken almost immediately, and it is important to minimize any loss in strength and range of motion in the knee. Physical therapists are an important part of the treatment team and are usually involved in the planning phase before surgery.

Rehabilitation may take six to nine months to return to full activity:

• In the first two to three weeks, the goal for physical therapy is to increase range of motion of the knee in a controlled fashion. Since the cruciate ligament graft needs time to heal in place, excessive flexing or bending is discouraged so that the graft doesn't rip out of place. The goal in the first couple of weeks is full extension (straightening) of the knee and 90 degrees flexion (bending).
• In three to six weeks, the goal is to get full range of motion of the knee. Strengthening exercises may be considered and bicycles are stair-climbers are often used.
• For the next many months, the goal is to increase strength and agility while maintain range of motion. The progress is closely monitored by the surgeon and physical therapist, again to protect the reconstructed knee and to push the patient to the goal of full recovery.

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